Feasibility and usability of measuring receipt of sealants in 2 states

BackgroundThe authors examined the reliability and validity of the Dental Quality Alliance childhood sealant measure under actual use conditions in Texas and Florida. The 2 states provide care for almost 20% of children in Medicaid nationally.MethodsThe authors used dental claims data to examine the reliability of the caries risk assessment component of the measure. They examined validity using a 3-year look-back period to identify children who were inaccurately included in the measure denominator as sealant eligible when they were not owing to already sealed, missing, or restored teeth.ResultsThe children identified at elevated risk varied between the states, with 85% at elevated risk in Texas and 39% in Florida in 2017. Different methods can be used to calculate risk, raising questions about reliability. In Texas, 31% of children included in the denominator were not eligible to receive sealants owing to already sealed, missing, or restored teeth. The magnitude of the underestimation increased with age, so by the time children were 9 years old, 40% were not measure eligible yet included in the denominator. Similar results were observed for Florida.ConclusionsThe authors propose eliminating the caries risk assessment requirement and incorporating a 3-year look-back period to identify already sealed, missing, or restored molars.Practical ImplicationsThe reliability and validity of the sealant measure needs to be enhanced. Measure misspecification in which children are not correctly identified as needing sealants can contribute to inaccurate development of quality improvement goals, performance improvement projects, or pay-for-quality programs.     

How should we regulate risk in biomedical research? An ethical analysis of recent policy proposals and initiatives

The existing regulatory framework for research is increasingly attacked for its “one-size-fits-all” approach. Many stakeholders contend that existing regulations formulate the same regulatory requirements for research involving very different levels of risk, and thereby unnecessarily stifle medical progress. To address this criticism, regulators are currently developing more risk-adapted approaches to regulating research. A key feature of these approaches is that they aim to calibrate subject protections, including ethical review and safety monitoring, to the risks that studies pose to participants.     

Spatial distribution of specialized cardiac care units in the state of Santa Catarina

OBJECTIVE

To analyze the methodology used for assessing the spatial distribution of specialized cardiac care units.

METHODS

A modeling and simulation method was adopted for the practical application of cardiac care service in the state of Santa Catarina, Southern Brazil, using the p-median model. As the state is divided into 21 health care regions, a methodology which suggests an arrangement of eight intermediate cardiac care units was analyzed, comparing the results obtained using data from 1996 and 2012.

RESULTS

Results obtained using data from 2012 indicated significant changes in the state, particularly in relation to the increased population density in the coastal regions. The current study provided a satisfactory response, indicated by the homogeneity of the results regarding the location of the intermediate cardiac care units and their respective regional administrations, thereby decreasing the average distance traveled by users to health care units, located in higher population density areas. The validity of the model was corroborated through the analysis of the allocation of the median vertices proposed in 1996 and 2012.

CONCLUSIONS

The current spatial distribution of specialized cardiac care units is more homogeneous and reflects the demographic changes that have occurred in the state over the last 17 years. The comparison between the two simulations and the current configuration showed the validity of the proposed model as an aid in decision making for system expansion.     

Risk factors for absenteeism due to sick leave in the petroleum industry

OBJECTIVE

To identify risk factors for absenteeism among workers with sick leave in an oil company.

METHODS

A case-control study (120 cases and 656 controls) nested in a retrospective cohort study following up all employees of an oil company in the North-Northeast of Brazil from 2007 to 2009. The response variable used to represent absenteeism with sick leave was the average incidence of sick leave, defined as the ratio between total sick days and potential working days in the period. Logistic regression techniques were used to investigate the association between average incidence of sick leave > 5.0% over the period and the variables sex, position, age, time at work, shift work, smoking, arterial hypertension, body mass index, physical activity, coronary risk, sleep, glycemia, non-managed diabetes, cardiovascular, digestive, musculoskeletal, neurological and neoplastic diseases, straining body positioning during work, satisfaction at work, relationship with management, and concentrated attention at work.

RESULTS

Average incidence of sick leave higher than 5.0% in the cohort period was 15.5%. The logistic model revealed that workers with average incidence of sick leave higher than 5.0% were 2.6 times more likely to be female; 2.0 time more likely to be smokers; 1.8 time more likely to be former smokers; 2.2 times more likely to report abnormal sleep and 10.5 times more likely to report dissatisfaction with their than workers with average incidence of sick leave ≤ 5.0% in the period.

CONCLUSIONS

In this population, female gender, being a smoker or a former smoker, reporting dissatisfaction with the job and reporting abnormal sleep are good predictors of occupational absenteeism with sick leave.     

Screening for depressive symptoms in older adults in the Family Health Strategy,Porto Alegre,Brazil

OBJECTIVE

To analyze the prevalence of depression in older adults and associated factors.

METHODS

Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity.

RESULTS

The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression.

CONCLUSIONS

A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.     

Model for the evaluation of drug-dispensing services in primary health care

OBJECTIVE

To develop a model for evaluating the efficacy of drug-dispensing service in primary health care.

METHODS

An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires.

RESULTS

The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension.

CONCLUSIONS

Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system.